Central Virginia Business Directory - Platinum Membership Form

Featured Company Data Input Form

Welcome to the Platinum Membership Program!

If you need help or have a question, contact us.
Please supply the following information used for your order as well as for your Company Profile page.

Company Name:

Your Name:

Your email:

(Used only for contact purposes)

Your Title:

Street address:

Address (cont.):

City:

State:

Zip Code:

Office Phone:

FAX:

Company E-mail:

Toll-free number:

URL of Company website

Please select one of these options

(You may select more than one option for an additional cost)

A banner (designed by your company)
      for 6 months for your directory listing(s)
A five-line description
      for your directory listing(s)
Up to three additional category listings
Three months of "coupons & sales"
      advertising

We will contact you about the details
of the option you have chosen.

Method of
contact

Best time to call

You may leave any category blank if it does not apply to your Company.
What is your company slogan? (example: "We care about your business")

Please describe your company in no more than 150 words.

Products and/or Services (up to 10)

Do you sell any specific brand names? (up to 10, separate with commas)

What days/hours are you open for business?

To what associations or trade groups do your belong? (example: Chamber of Commerce)

What licenses or permits do you have (if applicable) ? (We will list up to 5)

Can customers order your products or services online?

Yes
No

Are there any additional comments or details you would like displayed at the bottom of your page?
(no more than 500 words)

Which sidebar color would you like for your detail page? (see example)

black

navy

red

maroon

blue

brown

teal

green

White (no sidebar)

Thank you for becoming a Platinum Member!

Your Order will be processed within five business days of our receipt of your payment.
Print this form as your receipt for this order.

We Also accept PayPal Payments

If paying by check, please mail your payment to:

Accounting & Computer Enterprises, Inc.
1904 Westgate Cir
Williamsburg, VA 23185-2092

Questions? Call 434-385-1654.

Web Hosting